ABSTRACT Nearly 500,000 older adults are admitted to the hospital annually with traumatic injury. For many severely injured patients, injury from a fall or car crash is a terminal event leading to a 20% in-hospital and 40% one- year mortality. Severe traumatic injury can burden older patients with aggressive treatments they do not want because these treatments often have limited ability to prolong survival or return patients to the quality of life they had before their injury. Given the burdens of treatment and poor prognosis, severely injured older adults would benefit from decision support interventions that facilitate early access to palliative care, which can reduce unwanted invasive procedures, address symptoms and clarify goals. This proposal serves the long- term goal of improving communication for older adults who, together with their family, are facing decisions about invasive treatments?so that their treatment choices reflect personal preferences and goals. ?A communication tool to assist severely injured older adults? is a two-year R21 that responds specifically to PA-13-355 for ?development and evaluation of innovative decision aids for seriously ill older patients and/or their proxy decision makers.? Our research team has developed a novel communication tool called ?best case/worst case? that employs narrative and a graphic aid to illustrate options, express uncertainty and describe outcomes within the context of the patient's underlying health. We have demonstrated that surgeons can learn to use the tool and it is acceptable to patients in the acute care setting, we now need to adapt and test this tool for use with a cohort of patients who are most likely to benefit from early access to palliative care. This project has two aims: Aim 1, to adapt the best case/worst case communication tool to the trauma setting; Aim 2, to test the effect of teaching trauma care providers to use the best case/worst case tool on the quality of communication. This award will produce a decision-making intervention for use in the trauma setting, knowledge about the effect of the intervention on communication, and preliminary data for a future large-scale efficacy study. The research is innovative because it tests a novel, theoretically grounded intervention in a setting where patients and families are most likely to benefit. The research is significant because if the intervention is effective, it offers a low-cost strategy to improve communication with families of older patients with traumatic injury. We are well positioned to achieve our objectives within the scope of this award because we are adapting an existing intervention and evaluating an important intermediate outcome ?quality of communication? with high potential to impact downstream health outcomes.